Primary Health Care 1

Jhonessa L. Morillo
 Table of Contents

Module 1: Concepts of Health and Illness 1

Introduction 1
Learning Outcomes 1
Lesson 1. Definition of Health, Illness and Wellness 2
Lesson 2. Different Dimensions and Models of Wellness 3
Lesson 3. Health Promotion 7
Summary 9
Assessment Task 1 11

Module 2: Health as a Multifactorial Phenomenon 12

Introduction 13
Learning Outcomes 13
Lesson 1. Factors Affecting Health 13
Lesson 2. Illness Behavior 19
Summary 24
Assessment task 2 25

Module 3: Philippine Health Care System 27

Introduction 27
Learning Outcomes 27
Lesson 1. The Philippine Health Care Delivery System 28
Lesson 2. Components of the Philippine
Health Care Delivery System 41

Lesson 3. Levels of Health Care Facilities and Services 58

Lesson 4. The National Health Plan 2017-2022 62
Summary 63
Assessment Task 3-1 65
Assessment Task 3-2 66

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Course Code: PHC 1

Course description: Concepts and principles in the provision of basic

services of health promotion/ maintenance and disease prevention at the
individual and family level.

Course Outcomes:

At the end of the course the student should be able to:

1. Demonstrate skills in providing basic health care in terms of health
promotion, maintenance and disease prevention at the individual and
family level guided by the health care process.
2. Carry out primary health care services to individual, family and
community.
3. Work with the community Health Care Team in organizing, mobilizing
the community towards health and human development.

Course Requirements:
 Assessment Tasks - 60%
 Major Exams - 40%
_________
Periodic Grade 100%

PRELIM GRADE = 60% (Activity 1-4) + 40% (Prelim exam)

MIDTERM GRADE = 30% (Prelim Grade) + 70 % [60% (Activity 5-7) + 40%
(Midterm exam)]
FINAL GRADE = 30% (Midterm Grade) + 70 % [60% (Activity 8-10) + 40%
(Final exam)]

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 MODULE 1

Concepts of Health and Illness

Introduction

Midwives need to clarify their understanding of health and wellness because their
definitions largely determine the scope and nature of midwifery practice. Clients’ health
beliefs also influence their health practices. Some people think of health and wellness (or
well-being) as the same thing or, at the very least, as accompanying one another. However,
health may not always accompany well-being: A person who has a terminal illness may
have a sense of well-being; conversely, another person may lack a sense of well-being yet
be in a state of good health. For many years the concept of disease was the yardstick by
which health was measured. In the late 19th century the “how” of disease (pathogenesis)
was the major concern of the health professionals. Currently the emphasis on health and
wellness is increasing (Kozier, Erb, Berman, & Snyder, 2008).

Learning Outcomes

At the end of this module, students should be able to:

1. Differentiate health, wellness and well-being.
2. Describe and apply the different dimensions of wellness.
3. Compare various models of health.
4. Relate the levels of preventions to the practice in family and community.
5. Describe factors affecting healthcare adherence.

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Lesson 1. Definition of Health, Illness and Wellness

Health
There is no definite definition of health. There is knowledge of how to attain a
certain level of health, but health cannot be measured.

Traditionally, health has been defined in terms of the presence or absence of

disease. The World Health Organization (WHO) takes a more holistic view of health. Its
constitution defines health as “a state of complete physical, mental and social well-being,
and not merely the absence of disease or infirmity.” The following are some personal
definition of health:

 Health is the ability to maintain the internal milieu. Illness is the result of failure to
maintain the internal environment. (Claude Bernard)
 Health is the ability to maintain homeostasis or dynamic equilibrium.
Homeostasis is regulated by the negative feedback mechanism. (Walter Cannon)
 Health is being well and using one's power to the fullest extent. Health is
maintained through prevention of disease via environmental health factors.
(Florence Nightingale)
 Health is viewed in terms of the. Individual’s ability to perform 14 components of
nursing care unaided. (Virginia Henderson)
 Positive health symbolizes wellness. It is a value term defined by the culture or
individual. (Martha Rogers)
 Health is a state and a process of being and becoming an integrated and whole
person. (Sister Callista Roy)
 Health is a state that is characterized by soundness or wholeness of developed
human structures and of bodily and mental functioning. (Dorothea Orem)
 Health is a dynamic state in the life cycle; illness is an interference in the life
cycle. (King)
 Wellness is the condition in which all parts and subparts of an individual are in
harmony with the whole system. (Betty Neuman)

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 Illness
Illness is a highly personal state in which the person's physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be diminished.
It is not synonymous with disease and may or may not be related to disease (Udan,
2002).

Wellness
Wellness is a state of well-being. Basic concepts of wellness include self-
responsibility; an ultimate goal; a dynamic, growing process; daily decision making. It
involves engaging in attitudes and behaviors that enhance quality of life and
maximize personal potential. It is the integration of body, mind and spirit (Udan,
2002).

Lesson 2. Different Dimensions and Models of Wellness

Dimensions of Wellness (Udan, 2002)

1. Physical. The ability to carry out daily tasks, achieve fitness (pulmonary, cardio, GI),
maintain adequate nutrition and proper body fat, avoid abusing drugs and alcohol or
using tobacco products, and
generally to practice positive
lifestyle habits.
2. Social. The ability to interact
successfully with people and within
the environment of which each
person is a part, to develop and
maintain intimacy with significant
others, and to develop respect and Figure 1.1 Dimensions of Wellness
tolerance for those with different
opinions and beliefs.

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3. Emotional. The ability to manage stress and to express emotions appropriately.
Emotional wellness involves the ability to recognize, accept, and express feelings and to
accept one’s limitations.
4. Intellectual. The ability to learn and us information effectively for personal, family, and
career development. Intellectual wellness involves striving for continued growth and
learning to deal with new challenges effectively.
5. Spiritual. The belief in some force (nature, science, religion or higher power) that serves
to unite human beings and provide meaning and purpose to life. It includes person’s own
morals, values and ethics.
6. Occupational. The ability to achieve balance between work and leisure time. A person’s
belief about education, employment and home influence personal satisfaction and
relationships with others.
7. Environmental. The ability to promote health measures that improve the standard of
living and quality of life in the community. This includes influences such as food, water
and air.
8. Financial. Satisfaction with current and future financial situations.

Models of Health
1. Agent-Host- Environment Model
The agent-host-environment model of
health and illness, also called ecologic model,
originated in the community heath work of Leavell
and Clark (as cited in Kozier, 2008) and has been
expanded into a general theory of the multiple
causes of disease. The model is used primarily in
predicting illness rather than in promoting
wellness, although identification of risk factors
Figure 1.2 Agent-Host-Environment Model
that result from the interactions of agent, host and
environment are helpful in promoting and maintaining health.

1. Agent: Any environmental factor or stressor (biologic. chemical. mechanical,

physical. or psychosocial) that by its presence or absence (e.g. lack of essential
nutrients) can lead to illness or disease.

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 2. Host. Person(s) who may or may not be at risk of acquiring a disease. Family history,
age and lifestyle habits influence the host's reaction.
3. Environment. All factors external to the host that may or may not predispose the
person to the development of disease. Physical environment includes climate, living
conditions sound (noise) levels, and economic level. Social environment includes
interactions with others and life events, such as the death of a spouse.
Because each of the agent-host-environment factors constantly interacts with the
others, health is an ever-changing state. When the variables are in balance, health is
maintained; when variables are not in balance, disease occurs.

2. Dunn's High-Level Wellness Grid

Dunn (as cited in Kozier 2004), describes a health grid in which a health axis an
environmental axis intersects. The grid demonstrates the interaction of the environment with
the illness-wellness continuum. The health axis extends from peak wellness to death, and
the environmental axis extends from very favorable to very unfavorable. The intersection of
the two axes forms four quadrants of health and wellness:
a. High-level wellness in a favorable environment. An example is a person who
implements healthy lifestyle behaviors and has the biopsychosocial, spiritual and
economic resources to support this lifestyle.
b. Emergent high-level wellness in an unfavorable environment. An example is a
woman who has the knowledge to implement healthy lifestyle practices but does not
implement adequate self-care practices because of family responsibilities, job
demands, or other factors.
c. Protected poor health in a favorable environment. An ex-ample is an ill person (e.g.,
one with multiple fractures or severe hypertension) whose needs are met by the
health care system and who has access to appropriate medications, diet, and health
care instruction.
d. Poor health in an unfavorable environment. An example is a young child who is
starving in a drought-stricken country.

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Figure 1.3 Dunn's High-Level Wellness
3. Travis' Illness—Wellness Continuum
The illness-wellness continuum developed by Travis ranges from high-level wellness
to premature death. The model illustrates two arrows pointing in opposite directions and
joined at a neutral point. Movement to the right of the neutral point indicates increasing
levels of health and well-being for an individual. This is achieved in three steps: (a)
awareness, (b) education, and (c) growth. In contrast, movement to the left of the neutral
point indicates progressively decreasing level of health. Travis and Ryan believe it is
possible to be physically ill and at the same time oriented toward health, or by physically
healthy and at the same time function from an illness mentality (Travis, Ryan, as cited in
Kozier, 2004).

Figure 1.4 Travis' Illness—Wellness Continuum

4. Health Belief Model (HBM) (Becker, as cited in Kozier 2004)

 Individual perceptions and modifying factors may influence health beliefs and
preventive health behavior.
 Individual perceptions include the following:
1. Perceived susceptibility
2. Perceived seriousness
3. Perceived threat
 Modifying factors include the following:
1. Demographic variables (age, sex, race, etc.)
2. Sociopsychological variables (social pressure or influence or influence from
peers, etc.)
3. Structural variables (knowledge about the disease, and prior contact with it).
4. Cues to action. (Internal: fatigue, uncomfortable symptoms; external: mass
media, advice from others, etc.)

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  Likelihood of action depends on:
1. Perceived benefits of preventive action.
2. Perceived barriers to action.

5. Smith's Models of Health

a. Clinical Model. Views people as physiologic systems with related functions and
identifies health as the absence of signs and symptoms of disease or injury.
b. Role Performance Model. Defines health in terms of the individual's ability to fulfill
societal roles -perform work.
c. Adaptive Model. Focuses on adaptation. Views health as a creative process; and
disease as a failure in adaptation or maladaptation. This model believes that the aim
of treatment is to restore the ability of the person to adapt or to cope.
d. Eudemonistic Mode. Conceptualizes that health is a condition of actualization or
realization of a person's potential. This model avers that the highest aspiration of
people is fulfillment and complete development of self-actualization.

Lesson 3. Health Promotion

Health promotion is an important component of nursing practice. It is a way of
thinking that revolves around a philosophy of wholeness, wellness, and well-being (Kozier,
2004). In the past two decades, the public has become increasingly aware of and interested
in health promotion. Many people are aware of the relationship between lifestyle and illness
and are developing health-promoting habits, such as getting adequate exercise, rest, and
relaxation; maintaining good nutrition; and controlling the use of tobacco, alcohol, and other
drugs.
Health promotion or activities directed toward increasing the level of well-being and self-
actualization (Maslow, as cited in Kozier 2004).
1. It includes efforts to assist individuals and take control of and responsibility of their
health risk and ultimately improve quality-of-life.
2. Encompasses activities to improve the health of those who are not initially healthy as
well as the healthy individuals.
3. Include individual and community activities to promote healthful lifestyle.
4. Involves the principles of self-responsibility, and additional awareness, stress
reduction and management and physical fitness.

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Types of health promotion programs:
1. Information dissemination: use a variety of media to offer information to the public
about the particular lifestyle choices and personal behavior, the benefits of changing
that behavior and improving the quality of life.
2. Health appraisal of wellness assessment programs: appraise individuals of their risk
factors that are inherent in their lives in order to motivate them to reduce specific risk
and develop positive health habits.
3. Lifestyle and behavior change programs: basis for changing health behavior and
hear the word enhancing the quality of life and extending the life span.
4. Worksite wellness programs: include programs that serve the needs of persons in
their workplace.
5. Byron mental control programs: developed to address the growing problem of
environment pollution (air, land, water, etc.)

Three levels of prevention (Udan, 2002):

1. Primary prevention: encourage optimal health and to increase the person's
resistance to illness
- Health promotion
- Specific protection
2. Secondary prevention: it is also known as health maintenance.
- early diagnosis/detection/screening
- Prompt treatment to limit disability
3. Usually prevention: to support the client’s achievement of successful adaptation to
known risks, optimal reconstitution, and/or establishment of high-level wellness.
Behaviors associated with the levels of prevention
1. Primary prevention
- quit smoking - Take adequate fluids
- Avoid or limit alcohol intake - Avoid over exposure to sunlight
- Exercise regularly - Maintain ideal body weight
- Eat a well-balanced diet - Complete immunization program
- Reduced fat and increase fiber in - Wear PPE in worksite
diet

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 2. Secondary prevention
- physical exam
- Regular Pap test for women
- Monthly BSC for women who are 20 years old and above
- Sputum exam for tuberculosis
- Annual stool guaiac test and rectal examination of her clients over age 50
years
3. Tertiary prevention:
- Self-monitoring of blood glucose among diabetics
- Physical therapy after CVA
- Participate in cardiac rehabilitation after MI
- Attend self-management education for diabetes
- Undergo speech therapy after laryngectomy.

Summary

1. Definition of Health, Illness and Wellness

 Health is a state of complete physical, mental and social well-being, and not merely
the absence of disease or infirmity (WHO, n.d.).
 Illness is a highly personal state in which the person's physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be diminished
(Udan, 2002).
 Wellness is a state of well-being. Basic concepts of wellness include self-
responsibility; an ultimate goal; a dynamic, growing process; daily decision making. It
involves engaging in attitudes and behaviors that enhance quality of life and
maximize personal potential (Udan 2002).

2. Dimensions of Wellness
Wellness is commonly viewed as having eight (8) dimensions (Physical, Social,
Emotional, Intellectual, Spiritual, Occupational, Environmental, Financial) Each
dimension contributes to our own sense of wellness or quality of life, and each affect
and overlaps the others. At times one may be more prominent than others, but

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 neglect of any one dimension for any length of time has adverse effects on overall
health (Udan 2002).
3. Different Models of Wellness
 Agent-Host- Environment Model- The model is used primarily in predicting illness
rather than in promoting wellness, although identification of risk factors that result
from the interactions of agent, host and environment are helpful in promoting and
maintaining health (Leavell and Clark as cited in Kozier, 2004).
 Dunn's High-Level Wellness Grid - Dunn (1959) describes a health grid in which a
health axis an environmental axis intersects. The grid demonstrates the interaction of
the environment with the illness-wellness continuum (Dunn as cited in Kozier 2004).
 Travis's Illness—Wellness Continuum- The illness-wellness continuum developed by
Travis ranges from high-level wellness to premature death. The model illustrates two
arrows pointing in opposite directions and joined at a neutral point (Travis, Ryan, as
cited in Kozier, 2004).
 Health Belief Model (HBM) - Individual perceptions and modifying factors may
influence health beliefs and preventive health behavior (Becker, as cited in Kozier
2004).
Smith's Models of Health- indicates that numerous factors contribute to a person's
perception of health such as Clinical Model, Role Model, Adaptive Model, and
Eudemonistic Model (Smith as cited in Kozier, 2004)

4. Health Promotion (Kozier, 2004)

 Health promotion is the process of enabling people to increase control over, and to
improve their health.
 Health Promotion is divided into three (3) levels:
- Primary: aims to avoid the development of a disease or disability in healthy
individuals, it encourages optimal health and to increase the person's resistance
to illness
- Secondary: The focus of secondary prevention is early disease detection, making
it possible to prevent the worsening of the disease and the emergence of
symptoms, or to minimize complications and limit disabilities before the disease
becomes severe

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 - Tertiary: those preventive measures aimed at rehabilitation following significant
illness. At this level health services workers can work to retrain, re-educate and
rehabilitate people who have already developed an impairment or disability.

Assessment Task 1

Jerry and Joe have both suffered heart attacks. Jerry, upon advice from his Physician, started
exercising, changed his intake, entered stress reduction classes, and returned to work six
weeks after his heart attack. He has a positive outlook, is doing well, and talks about being
well. Joe also changed his dietary habits and started exercising. However, Joe has been able
to quit smoking even though he wants to and has been advised to do so. Joe is frequently
despondent, very fearful of having another heart attack, has not yet returned to work and
frequently talks about being ill.

1. How does Jerry’s psychological dimension of health status differ from Joe’s?
2. What external factors may have influenced Jerry’s decision to implement positive
health behaviors?
3. What interventions would be most beneficial to Joe concerning his smoking problem?
4. What level of prevention can you apply to Jerry and Joe? Explain your answer

References

Cuevas, F., Reyala, J., Earnshaw, R., Bonito, S., Sitioco, J., Serafica, L. (Eds.). (2007).
Public health nursing in the Philippines (10 th ed.) Philippines: Publication Committee,
National League of Philippine Government Nurses, Inc.
Kozier, B., Erb, G., Berman A., Snyder, S. (2004). Fundamentals of nursing: Concept,
process and practice (8th ed.) New, Jurong, Singapore: Pearson Education Inc.
Peter, P. and Perry S. 1993. “Fundamentals of Nursing: Concepts, Process and Practice.”
3rd Ed. St.Louis: C.V. Mosby.
Udan, J., 2002. “Mastering Fundamentals of Nursing: Concepts and Clinical Application, A
Reference Book and Study Guide.” 1st ed. Manila Philippines.

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 MODULE 2

HEALTH AS A MULTIFACTORIAL
PHENOMENON

Introduction

Multifactorial health conditions are very common in the general population and
account for the majority of physical birth defects and chronic diseases. “Multifactorial” means
that “many factors” are involved in causing the medical problem. The factors are usually
both genetic/internal and environmental/external; a combination of many genes from both
parents, in addition to unknown environmental factors, produces the condition (Cuevas,
Reyala, Earnshaw, Bonito, Sitioco, Serafica, 2007).

For the majority of multifactorial health conditions, there is no genetic testing

available to determine who has inherited the genetic predisposition to develop the condition.
Therefore, when a person knows that there are multifactorial conditions present in close
family members, one must be knowledgeable about some of the environmental elements
that can trigger the development of the health condition (Kozier, 2004). For example, if the
father has heart disease, it is important to eat a healthy diet, exercise, and avoid smoking,
as all of these factors play a role in the development of heart problems. If the mother
suffered from melanoma, reducing sun exposure and wearing sunscreen is important. Early
screening is important especially if there is a history of genetic disorder to take
precautionary measures.

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 Learning Outcomes

At the end of this module, students should be able to:

1. Differentiate illness form disease and acute illness from chronic illness.
2. Identify Parson’s four (4) aspects of the sick role.
3. Explain Suchman’s stages of illness.
4. Describe effects of illness on individuals’ and family members’ roles and functions.

Lesson 1. Factors Affecting Health

According to Kozier (2004), many variables influence a person’s health status,

beliefs, and behaviors or practices. These factors may or may not be under conscious
control. People can usually control their health behaviors and can choose healthy or
unhealthy activities. In contrast, people have little or no choice over their genetic makeup,
age, sex, culture and sometimes their geographic boundaries.

Health status- State of health of an individual at a given time. A report of health status may
include anxiety, depression, or acute illness and thus describe the individual's problem in
general. Health status can also describe such specifics as pulse rate and body temperature.

Health beliefs- Concepts about health that an individual believes true. Such beliefs may or
may not be founded on fact. For example, some Southerners say that "high blood," meaning
too much blood in the body, causes headaches and dizziness.

Health behaviors- The actions people take to understand their health state, maintain an
optimal state of health, prevent illness and injury, and reach their maximum physical and
mental potential. Behaviors such as eating wisely, exercising, paying attention to signs of
illness, following treatment advice, avoiding known health hazards such as smoking, taking
time for rest and relaxation, and managing one's time effectively are all examples.

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1. Internal Variables
According to Kozier (2004), Internal variables include biologic, psychologic, and
cognitive dimensions. They are often described as non-modifiable variables because, for
the most part, they cannot be changed. However, when internal variables are linked to
health problems, the midwife must be even more diligent about working with the client to
influence external variables (such as exercise and diet) that may assist in health
promotion and prevention of illness. Regular health exams and appropriate screening for
early detection of health problems become even more important.

A. Biologic Dimension
Genetic makeup sex, age, and developmental level all significantly influence
a person's health.

i. Genetic makeup influences biologic characteristics, innate temperament,

activity level, and intellectual potential. It has been related to susceptibility
to specific disease, such as diabetes and breast cancer. In some cases,
genetic predisposition health or illness is enhanced when parents are
from the same clinic genetic pool. For example, people of African heritage
higher incidence of sickle-cell anemia and hypertension than general
population but may be less susceptible to malaria.
ii. Sex influences the distribution of disease. Certain acquired and genetic
diseases are more common in one sex than in other. Disorders more
common among females include osteoporosis and autoimmune disease
such as rheumatoid arthritis. Those more common among males are
stomach ulcers, abdominal hernias, and respiratory diseases. Age is also
a significant factor. The distribution of disease varies with age. For
example, arteriosclerotic heart disease is common in middle-aged males
but occurs infrequently its younger people; such communicable diseases
as whooping cough and measles are common in children but rare in
elders who have acquired immunity to them.

iii. Developmental level has a major impact on health status. Consider these
examples:

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  Infants lack in physiologic and psychologic maturity so their defenses
against disease are lower during the first year of life.
 Toddlers who are learning to walk are more prone to fall and injury.
 Adolescents who need to conform to peers are more prone to risk-
taking behavior and subsequent injury.
 Declining physical and perceptual abilities limit the ability of elders to
respond to environmental hazards and stressors.

B. Psychologic Dimension
Psychologic Dimension psychologic (emotional) factors influencing health
include mind-body interactions and self-concept.

Mind-body interactions can affect health status positively or negatively.

Emotional responses to stress affect body function. For example, a student who
is extremely anxious before a test may experience urinary frequency and
diarrhea. Prolonged emotional distress may increase susceptibility to organic
disease or precipitate it. Emotional distress may influence the immune system
through central nervous system and endocrine alterations. Alterations in the
immune system are related to the incidence of infections, cancer, and
autoimmune diseases.

Increasing attention is being given to the mind's ability to direct the body's
functioning. Relaxation, meditation, and biofeedback techniques are gaining
wider recognition by individuals and health care professionals. For example,
women often use relaxation techniques to decrease pain during child-birth. Other
people may learn biofeedback skills to reduce hypertension.

2. External Variables- External variables affecting health include the physical

environment standards of living, family and cultural beliefs, and social support networks
(Kozier, 2004).

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A. Environment
People are becoming increasingly aware of their environment and how it
affects their health and level of wellness. Geographical location determines
climate, and climate affects health. For instance, malaria and malaria-related
conditions occur more frequently in tropical rather than temperate climates.
Pollution of the water, air, and soil affects the health of cells. Pollution can occur
naturally (e.g. lightning-caused fires produce smoke, which pollutes the air).
Other substances in the environment, such as asbestos, are considered
carcinogenic (i.e., they cause cancer). Cigarette smoke is "hazardous to one's
health," with rates of cancer higher among smokers and those who live or work
near smokers.

Another environmental hazard is radiation. Two sources of radiation that can

be hazardous to health are machines and drugs that emit radiation. The improper
use of x-rays for example, can harm many of the body's organs. Another
common source of radiation is the sun's ultraviolet rays. Light-skinned people are
more susceptible to the harmful effects of the sun than are dark-skinned people.

B. Standard of Living

An individual’s standard of living (reflecting occupation, income and

education) is related to health, morbidity, and mortality. Hygiene, food habits, and the
propensity to seek health care advice and follow health regimens vary among high-
income and low-income group.

Low income families often define health in terms of work; if people can work,
they are healthy. They tend to be fatalistic and believe that illness is not preventable.
Because their present problems are so great and all efforts are exerted toward
survival, an orientation to the future may be lacking.

The environmental conditions of poverty-stricken areas also have a bearing

on overall health. Slum neighborhoods are over-crowded and in a state of
deterioration. Sanitation services tend to be inadequate. Many streets are strewn

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with garbage, and rats overrun alleys. Fires and crime are constant threats.
Recreational facilities are almost nonexistent, forcing children to play in streets and
alleys.

C. Family and Cultural Beliefs

The family passes on patterns of daily living and lifestyles to offspring. For
example, a man who was abused as a child may physically abuse his small son.
Physical or emotional abuse may cause long-term health problems. Emotional health
de-pends on a social environment that is free of excessive tension and does not
isolate the person from others. A climate of open communication, sharing, and love
fosters the fulfillment of the person's optimum potential.

Culture and social interactions also influence how a person perceives,

experiences, and copes with health and illness. Each culture has ideas about health,
and these are often transmitted from parents to children.

For example, a person of Asian origin may prefer to use herbal remedies and
acupuncture to treat pain rather than analgesic medications. Cultural rules, values,
and beliefs give people a sense of being stable and able to predict outcomes. The
challenging of old beliefs and values by second-generation cultural groups may give
rise to conflict, instability, and insecurity, in turn contributing to illness.

D. Social Support Networks

Having a support network (family, friends, or a confidant) and job satisfaction

helps people avoid illness. Support people also help the person confirm that illness
exists. People with inadequate support networks sometimes allow themselves to be-
come increasingly ill before confirming the illness and seeking therapy. Support
people also provide the stimulus for an ill per-son to become well again (Hurdle,
2001).

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Health Locus of Control Model

Locus of control (LOC) is a concept from social learning theory that nurses can use
to determine whether clients are likely to take action regarding health, that is, whether
clients believe that their health status is under their own or others' control. People who
believe that they have a major influence on their own health status that health is largely self-
determined are called internals. People who exercise internal control are more likely than
others to take the initiative on their own health care, be more knowledgeable about their
health, and adhere to prescribed health care regimens such as taking medication, making
and keeping appointments with physicians, maintaining diets, and giving up smoking. By
contrast, people who believe their health is largely controlled by outside forces (e.g., chance
or powerful others) are referred to as externals (Kozier, 2004).

Illness and Disease

Illness is a highly personal state in which the person's physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be diminished. It is
not synonymous with disease and may or may not be related to disease. An individual could
have a disease, for example, a growth in the stomach, and not feel ill. Similarly, a person
can feel ill, that is, feel uncomfortable, and yet have no discernible disease. Illness is highly
subjective: only the individual person can say he or she is ill (Kozier, 2004).

Disease can be described as an alteration in body functions resulting in a reduction

of capacities or a shortening of the normal life span. Traditionally intervention by physicians
has the goal of eliminating or ameliorating disease processes. Today multiple factors are
considered to interact in causing disease and determining an individual's response to
treatment (Udan, 2002).

The causation of a disease is called its etiology. A description of the etiology of a

disease includes the identification of all causal factors that act together to bring about the
particular disease. For example, the tubercle bacillus is designated as the biologic agent of
tuberculosis. However, other etiologic factors such as age, nutritional status, and even

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occupation, are involved in the development of tuberculosis and influence the course of
infection. There are many diseases for which the cause is unknown (e.g., multiple sclerosis)
Kozier, 2004).

Acute illness is typically characterized by severe symptoms of relatively short

duration. The symptoms often appear abruptly and subside quickly and, depending on the
cause, may or may not require intervention by health care professionals. Some acute
illnesses are serious (for example, appendicitis may require surgical intervention), but many
acute illnesses, such as colds, subside without medical intervention or with the help of over-
the-counter medications. Following an acute illness, most people return to their normal level
of wellness (Peter & Perry, 1993)

A chronic illness is one that lasts for an extended period, usually 6 months or longer,
and often for the person's life. Chronic illnesses usually have a slow onset and often have
periods of remission, when the symptoms disappear, and exacerbation, when the symptoms
reappear (Udan,2002).

Lesson 2: Illness Behaviors

When people become ill, they behave in certain ways that sociologists refer to as illness
behavior. Illness behavior, a coping mechanism, involves ways individuals describe,
monitor, and interpret their symptoms take remedial actions, and use the health care
system. How people behave when they are ill is highly individualized and affected by many
variables, such as age, sex, occupation, socioeconomic status, religion, ethnic origin,
psychologic stability, personality, education, and modes of coping.

Parsons as cited in Kozier et al., 2004 described four aspects of the sick role:
 Clients are not held responsible for their condition.
 Clients are excused from certain social roles and tasks.
 Clients are obliged to try to get well as quickly as possible. 4. Clients or their families
are obliged to seek competent help.

19
 Suchman (as cited in Kozier et al., 2004), describes five stages of illness: symptoms,
sick role, medical care contact, dependent client role, and recovery or rehabilitation. Not all
clients progress through each stage. For example, the client who experiences a sudden
heart attack is taken to the emergency room and immediately enters stages 3 and 4,
medical care contact and dependent client role. Other clients may progress through only the
first two stages and then recover.

Stage I: Symptom Experiences

At this stage the person comes to believe something is wrong. Either someone
significant mentions that the person looks un-well, or they experience some symptoms such
as pain, rash, cough, fever, or bleeding. Stage 1 has three aspects:
 The physical experience of symptoms
 The cognitive aspect (the interpretation of the symptoms in terms that have some
meaning to the person).
 The emotional response (e.g., fear or anxiety).

During this stage, the unwell person usually consults others about the symptoms or
feelings, validating with a spouse or support people that the symptoms are real. At this stage
the sick person may try home remedies. If self-management is ineffective, the individual
enters the next stage.

Stage 2: Assumption of the Sick Role

The individual now accepts the sick role and seeks confirmation from family and friends.
Often people continue with self-treatment and delay contact with health care professionals
as long as possible. During this stage people may be excused from normal duties and role
expectations. Emotional responses such as withdrawal, anxiety, fear, and depression are
not uncommon depending on the severity of the illness, perceived degree of disability, and
anticipated duration of the illness. When symptoms of illness persist or increase, the person
is motivated to seek professional help.
Stage 3: Medical Care Contact
Sick people seek the advice of a health professional either their own initiative or at
the urging of significant others. When people seek professional advice, they are really
asking for three types of information:

20
  Validation of real illness
 Explanation of the symptoms in understandable terms
 Reassurance that they will be all right or prediction of what the outcome will be.

The health professional may determine that the client does not have an illness or that an
illness is present and may even be life threatening. The client may accept or deny the
diagnosis. If the diagnosis is accepted, the client usually follows, the prescribed vestment
plan. If the diagnosis is not accepted, the client may seek the advice of other health care
professionals or quasi-practitioners who will provide a diagnosis that the client's perceptions.

Stage: 4 Dependent Client Role

After accepting the illness and seeking treatment, the client becomes dependent on
the professional for help. People vary greatly in the degree of ease with which they can give
up their independence, particularly in relation to life and death. Role obligations such as
those of wage earner father, mother, student, baseball team member, or choir member-
complicate the decision to give up independence.

Most people accept their dependence on the physician, al-though they retain varying
degrees of control over their own lives. For example, some people request precise
information about their disease, their treatment, and the cost of treatment, and they delay
the decision to accept treatment until they have all this information. Others prefer that the
physician proceed with treatment and do not request additional information.

For some client’s illness may meet dependence needs that have never been met and
thus provide satisfaction. Other people have minimal dependence needs and do everything
possible to return to independent functioning. A few: may even try to maintain independence
to the detriment of their recovery.

Stage 5: Recovery or Rehabilitation

During this stage the client is expected to relinquish the de-pendent rule and resume
former roles and responsibilities. For people with acute illness, the time as an ill person is
generally short and recovery is usually rapid. Thus, most find it relatively easy to return to

21
their former lifestyles. People who have long term illnesses and must adjust their lifestyles
may find recovery more difficult. For clients with a permanent disability, this final stage may
require therapy to learn how to make major adjustments in functioning.

Effects of Illness
Illness brings about changes in both the involved individual and in the family. The
changes vary depending on the nature, severity, and duration of the illness, attitudes
associated with the illness by the client and others, the financial demands, the lifestyle
changes incurred, adjustments to usual roles, and so on (Peter & Perry 1993).

a. Impact on the Client

Ill clients my experience behavioral and emotional changes, changes in self-concept
and body image, and lifestyle changes. Behavioral and emotional changes associated
with short-term illness are generally mild and short-lived. The individual, for example,
may become irritable and lack energy or desire to interact in the usual fashion with
family members or friends. More accurate responses are likely with severe, life-
threatening, chronic, or disabling illness. Anxiety, fear, anger, withdrawal, denial, a
sense of hopelessness, and feelings of powerlessness are all common responses to
severe or disabling illnesses.

Certain illnesses can also change the client's body image or physical appearance,
especially if there is severe scarring or loss of a limb or special sense organ. The client
self-esteem and self-concept may also be affected. Many factors can play a part in low
self-esteem and a disturbance in self-concept: loss of body parts and function, pain,
disfigurement, dependence on others, unemployment, financial problems, inability to
participate in social functions, strained relationships with others, and spiritual distress.
Midwives need to help clients express their thoughts and feelings, and to provide care
that helps the client effectively cope with change.

Ill individuals are also vulnerable to loss of autonomy, the state of being independent
and self-directed without outside control. Family interactions may change so that the

22
client may no longer be involved in making family decisions or even decisions about their
own health care. Midwives need to support clients' right to self-determination and
autonomy as much as possible by providing them with sufficient information to
participate in decision-making processes and to maintain a feeling of being in control.

Illness also often necessitates a change in lifestyle. In addition to participating in

treatment and taking medications, the old person may need to change diet, activity and
exercise, and rest and sleep patterns.
Midwives and help clients adjust their lifestyles by these means:
 Providing explanations about necessary adjustments
 Making arrangements or wherever possible to accommodate the client’s lifestyle
 Encouraging other health professionals to become aware of the person's lifestyle
practices and to support healthy aspect of that lifestyle
 Reinforcing the variable changes in practices with a view of making them for me
and part of the client's lifestyle.

b. Impact on the family

A person's all this affects not only the person who is ill but also the family or
significant others. The kind of effect and its extent depends chiefly on the three
factors: The member of the family who is you, the seriousness in the length of the
illness, and the cultural and social customs in the family follows.
The changes that can occur in the family include the following:
 Role changes
 Task reassignments and increased demands on time
 Increased stress due to anxiety about the outcome of the illness for the client
and conflicts about unaccustomed and responsibilities.
 Financial problems
 Loneliness as a result of separation and pending loss
 Change in social customs

23
Summary

1. Factors affecting health

 Internal Variables: They are often described as non-modifiable variables because, for
the most part, they cannot be changed.
- Biologic Dimension are genetic makeup sex, age, and developmental level all
significantly influence a person's health.
- Psychologic Dimension psychologic (emotional) factors influencing health include
mind-body interactions and self-concept.
 External Variables- External variables affecting health include the physical
environment standards of living, family and cultural beliefs, and social support
networks (Kozier, 2004).
2. Locus of control (LOC) is a concept from social learning theory that nurses can use to
determine whether clients are likely to take action regarding health, that is, whether
clients believe that their health status is under their own or others' control (Kozier, 2004).
3. Illness and disease
 Disease can be described as an alteration in body functions resulting in a reduction
of capacities or a shortening of the normal life span.
 Etiology is the causation of a disease
 Acute illness is typically characterized by severe symptoms of relatively short
duration.
 Chronic illness is one that lasts for an extended period, usually 6 months or longer,
and often for the person's life.
4. Illness Behavior
 Symptom Experience- At this stage the person comes to believe something is
wrong.
 Assumption of the Sick Role- The individual now accepts the sick role and seeks
confirmation from family and friends
 Medical Care Contact- Sick people seek the advice of a health professional
either their own initiative or at the urging of significant others.
 Dependent Sick Role- the client becomes dependent on the professional for help.
Role obligations such as those of wage earner father, mother, student, baseball

24
 team member, or choir member-complicate the decision to give up independence
(Kozier, 2004).
 Recovery or Rehabilitation- During this stage the client is expected to relinquish
the de-pendent rule and resume former roles and responsibilities.
5. Effects of Illness
 Illness brings about changes in both the involved individual and in the family. The
changes vary depending on the nature, severity, and duration of the illness,
attitudes associated with the illness by the client and others, the financial
demands, the lifestyle changes incurred, adjustments to usual roles, and so on
(Peter & Perry 1993).

Assessment Task 2

Mrs. Janet Brown is a 36-year-old woman, who was recently diagnosed with cancer. She
has been a client at the clinic where you work for several years, calling in every few
weeks and/or having frequent appointments. Typically, her clinical symptoms have been
vague; however, she has often seemed something about them. Her recent diagnosis
initially seemed to make her be more content and settled. However, now it seems that
she is escalating in her behavior and talking about no one caring about her (including her
family), that your clinic does not understand her, and she’s just generally being
unreasonable on the phone and in person.
1. How do you make sense of these clients' illness behavior? Is it abnormal? Explain
your answer.
2. What strategies might you use to deal with this client?
3. How can you apply your understanding to the topics discussed in this module to the
client’s situation?
4. How do healthcare professionals influence the illness behavior of clients and
families? Using this module as a guide, how would you support and work with an
individual that has cancer?
5. How do your own past experiences influence practice in this client?
6. There are no norms for individuals with long-term illness. What does this mean and
how does it apply to your population of clients with chronic illness?
25
References
Cuevas, F., Reyala, J., Earnshaw, R., Bonito, S., Sitioco, J., Serafica, L. (Eds.). (2007).
Public health nursing in the Philippines (10 th ed.) Philipines: Publication Committee,
National League of Philippine Government Nurses, Inc.
Kozier, B., Erb, G., Berman A., Snyder, S. (2008). Fundamentals of nursing: Concept,
process and practice (8th ed.) New, Jurong, Singapore: Pearson Education Inc.
Peter, P. and Perry S. 1993. “Fundamentals of Nursing: Concepts, Process and Practice.”
3rd Ed. St.Louis: C.V. Mosby.
Relaya, J., Nisce, Z., Martinez, F., Hizon, N., Ruzol, C., Dequina, R., Alcantara, A.,
Bermudez, T., Estinopa, G (2000). Community health nursing services in the
Philippines (9th ed.) Philippines: Publication Committee, National League of
Philippine Government Nurses, Inc.
Udan, J., 2002. “Mastering Fundamentals of Nursing: Concepts and Clinical Application, A
Reference Book and Study Guide.” 1st ed. Manila Philippines.

26
 MODULE 3

PHILIPPINE HEALTH CARE SYSTEM

Introduction

Health care system is an organized plan of health services. The rendering of health
care services to the people is called health care delivery system. Thus, health care delivery
system is the network of health facilities and personnel which carries out the task of
rendering health care to the people. In the Philippines health care system is complex set of
organizations interacting to provide an array of health services (Cuevas, 2007).

A Midwife does not function in a vacuum. She is a member of a team working within
a system. In order for the nurse to function effectively she has to understand the health care
delivery system wherein she is working because it influences her status and functions. She
needs to properly relate with the dynamics of the political, organizational structure
surrounding her position in the health care delivery system (All Answers Ltd., 2018).

Learning Outcomes

At the end of this module, students should be able to:

1. Analyze the National Health Situation of the Philippines

2. Identify components and functions of health care delivery systems
3. Explain the different levels of health care facilities
4. Analyze strategies of multi-sectoral collaboration and integration within health services

27
Lesson 1. The Philippine Health Care Delivery System

The Philippine health care delivery system according to Cuevas (2007) is composed
of two sectors: (1) the public sector, which is largely financed through a tax-based budgeting
system at both national and local levels and where health care is generally given free at the
point of service (although socialized user fees have been introduced in recent years for
certain types of services), and (2) the private sector (for-profit and non-profit providers),
which is largely market-oriented and where health care is paid through user fees at the point
of service.

The public sector consists of the national and local government agencies providing
health services. At the national level, the Department of Health (DOH) is mandated as the
lead agency in health. It has a regional field office in every region and maintains specialty
hospitals, regional hospitals and medical centers. It also maintains provincial health teams
made up of DOH representatives to the local health boards and personnel involved in
communicable disease control, specifically for malaria and schistosomiasis. Other national
government agencies providing health care services such as the Philippine General Hospital
are also part of this sector.

With the devolution of health services, the local health system is now run by Local
Government Units (LGUs). The provincial and district hospitals are under the provincial
government while the city/municipal government manages the health centers/rural health
units (RHUs) and barangay health stations (BHSs). In every province, city or municipality,
there is a local health board chaired by the local chief executive. Its function is mainly to
serve as an advisory body to the local executive and the Sanggunian or local legislative
council on health-related matters.

The private sector includes for-profit and nonprofit health providers. Their
involvement in maintaining the people's health is enormous. This includes providing health
services in clinics and hospitals, health insurance, manufacturing medical supplies,
equipment, and other health and of medicines, vaccines, nutrition products, research and

28
development, human resource development and other health-related services (Cuevas,
2007).

National Health Situation

The National Health Situation gives us an idea of the health situation in the
communities where healthcare provider work. Because of the different conditions prevailing
in these communities, their health picture expectedly varies. For example, goiter is highly
prevalent in the Mountain Province while Schistosomiasis is endemic in Leyte. The local
health situation, therefore, needs to be established for each province, city and municipality.

Demographic Profile

 The current population of the Philippines is 109,643,012 as of Saturday, July 18, 2020,
based on Worldometer elaboration of the latest United Nations data.
 The Philippines 2020 population is estimated at 109,581,078 people at mid-year
according to UN data.
 The Philippines population is equivalent to 1.41% of the total world population.
 The Philippines ranks number 13 in the list of countries (and dependencies) by
population.
 The population density in the
Philippines is 368 per Km2 (952
people per mi2).
 The total land area is 298,170 Km2
(115,124 sq. miles)
 47.5 % of the population
is urban (52,008,603 people in
2020)
 The median age in the Philippines
is 25.7 years.
(Worldometer, 2020.)
Figure 3.1 Philippine Population

29
 Table 3.1 Population of the Philippines
Annual average population growth rate (%) 2010-2015 2015-2020 2020-2025
1.73 1.59 1.41

Projected population 2020 2025 2030

Total 109,947,900 117,959,400 125,337,500
Male 55,460,900 59,494,400 63,202,900
Female 54,487,000 58,465,000 62,134,600

Projected life expectancy 2015-2020 2020-2025 2025-2030

Male 68.81 70.01 71.01
Female 74.34 75.54 76.54
Source: Department of Health (2020)

Births in the Philippines as of 2018 (DOH Annual Report 2018)

In 2018, a total of 1,668,120 live births were registered, which is equivalent to a

crude birth rate (CBR) of 15.8 or 16 births per thousand population.

The number of registered live births showed a decreasing trend, noticeably from 2012 to
2018. The decrease in the last six years was 6.8 percent, from 1,790,367 live births in 2012
to 1,668,120 recorded births in 2018.

On the average, there were about 4,570 babies born daily or about 190 babies born
per hour or approximately three babies born per minute.

30
 Figure 3.2. Registered number of live births in the Philippines 2008 to 2018

Highest occurrence of births in NCR

Of the total live births, 58.4 percent were born in Luzon, 18.5 percent in Visayas and
23.0 percent in Mindanao. Among the regions of the country, the National Capital Region
(NCR) recorded the highest number of birth occurrences with 14.3 percent. Second in rank
was CALABARZON (13.8%) and the third was Central Luzon (11.3%).

Figure 3.3 Distribution of live births by place of occurrence and by residence of mother 2018

Most number of births in September

In 2018, most births

occurred in September with
156,820 (9.4%) of the total births
in the country. It was followed by
the months of October (9.3%),
November (8.9%), and December
(8.8%). The month of February

31
Figure 3.4 Number and Percent of Distribution of Live
Births by Month, Philippines: 2018
had the least number of births in 2018.

Nine in ten birth deliveries are medically attended

Of the total number of births in the country, 94.3 percent birth deliveries were
attended by health professionals which may either be a physician, a midwife or a nurse.

The number of births by place of occurrence and by usual residence of mother

showed a remarkable proportion on births attended by health professionals in 16 regions.
This is indicative of improving health services in terms of maternal and child health care.
Among regions, only Autonomous Region in Muslim Mindanao (ARMM) showed a very low
proportion of medically attended births. Almost half of the births that occurred in the region
were attended by traditional birth attendants (hilot/unlicensed midwife) (PSA, 2018).

Figure 3.5 Percent distribution of live births by attendant at birth 2018

(Philippine Statistics Authority, n.d.)

Mortality Rate
An average of 1,618 deaths daily. Reported deaths according to DOH in 2018
reached 590,709, an increase of 2.0 percent from the previous year's 579,237 deaths. This
is equivalent to a crude death rate (CDR) of 5.6, or about six (6) persons per thousand
population. In 2018, an average of 1,618 persons died daily. This translates to 67 deaths per
hour or one (1) per minute. The number of deaths from 2009 to 2018 showed an increasing

32
trend except in the year 2017. The increase during the ten-year period is 22.9 percent, from
480,820 in 2009 to 590,709 in 2018.

Figure 3.6 Registered Number of Deaths and Percent Change in the Philippines: 2009 to 2018

Highest number of deaths recorded in CALABARZON (DOH Annual Report 2018)

The top three regions in terms of number of deaths by usual residence were found in
Luzon: CALABARZON with 85,816 or 14.5 percent, followed by NCR with 74,934 or 12 7
percent, then Central Luzon with 70,706 or 12.0 percent. The combined share of these three
regions was 39.2 percent of the total deaths.

Figure 3.7. Percent Distribution of Deaths by Usual Residence (Region) Philippines: 2018

33
January records the greatest number of deaths (DOH Annual Report 2018)
The month of January recorded the highest number of deaths with 52,126 or 8.8
percent, while February had the least number with 45,236 or 77 percent share of the total
deaths.

Daily Index is the increase/decrease from the overall daily average of event
occurrences. In 2018, the months of February to July fall below the national daily index of
100.0.

Figure 3.8. Percent distribution of deaths by month of occurrence 2018

More deaths in males than females

The graph below shows the age and sex pattern of deaths in 2018. It reflects an inverted
pyramid, with fewer deaths at the younger ages, except for children under one, and
progressively increasing as people grow older. In the Philippines, the number of deaths in
males (337,789) was higher than deaths in females (252,920) in 2018. 85 and over Highest
proportion of males 80-84 died at the age of 65 to 69 years (11.0% or 37,129 male deaths)
while largest proportion of females (16.5% or 41,741) died in their oldest age group, 85
years and over (DOH Annual Report 2018).
.

34
Figure 3.9. Percent Distribution of Deaths by Age Group and Sex, Philippines: 2018

In 2018, the sex ratio of 134 indicates that there are 134 male deaths for every 100
female deaths. It is clearly higher rate than females before reaching the age of 80 years,
which the sex ratio of over a hundred. Higher proportions of female deaths were observed in
the older age groups (80 years and over), compared to its male counterparts, which is
indicative of higher survival rate of females than males.

Highest number of infant deaths recorded in CALABARZON

Infant deaths are deaths that occurred before reaching age 1. At the national level,
21,019 infant deaths were registered in 2018. Six out of ten deaths were males (12,174 or
57.9%). The three regions that registered the highest infant deaths were CALABARZON
with 3,698 (17.6%), NCR with 3,495 (16.6%) and Central Luzon with 2,455 (11.7%).

35
 Figure 3.10. Percent distribution of infant deaths by sex and by usual residence (Region) 2018

Highest number of maternal deaths recorded in CALABARZON

According to the World Health Organization (WHO), maternal death is the “death of a
woman while pregnant or within 42 days of termination of pregnancy, irrespective of the
duration and site of the pregnancy, from any cause to or aggravated by the pregnancy or its
management but not from accidental or incidental causes”. In 2018, there were 1,616
registered maternal deaths in the country.

Among all regions, CALABARZON recorded the greatest number of maternal deaths
with 245 or 15.2% of the total, followed by Region VII with 230 or 14.2 percent, and NCR
with 18=95 or 12.1%. On the other hand, CAR and ARMM recorded the least number of
maternal deaths, each with only 12 or 0.7 percent of the total.

36
 Figure 3.11. Percent distribution of maternal deaths by usual residence (Region) 2018

Ischemic Heart Disease lead causes of deaths (DOH Annual Report 2018)
Figure 3.11 shown the ten leading causes of death in 2018. It can be seen
that among the total deaths, ischemic heart diseases were the leading causes of death with
88,433 or 15%. Neoplasms, which are commonly known as “cancer”, were the second
leading causes of death with 63,454 or 10.7% percent, followed by cerebrovascular
diseases with 61,959 or 10.5 percent.
Figur
e
3.12
Ten
leadi
ng
deat
h,
2018

Morbidity Report (DOH Annual Report 2018)

1. Tuberculosis
TB incidence (new cases per 100,000 population) in the Philippines has increased
from 434 in 2016 to 554 in 2018. On the other hand, the case notification rate has also
increased from 317 in 2016 to 350 in 2018. Treatment coverage has increased from 60
percent in 2016 to 63 percent in 2018. Furthermore, TB treatment success rate was
sustained at 91 percent from 2016 to 2018.

37
2. HIV/AIDS
By 2018, the total number of reported HIV cases (since January 1984) has risen to
62,029, which was 22.3 percent higher than the total reported cases that had been
recorded by 2017. The cumulative number of persons living with HIV (PLHIV) on
antiretroviral therapy (ART) was at 33,593 in 2018, which was 35.7 percent higher than
the recorded in 2017. Total deaths due to HIV/AIDS that have been reported since
January 1984 until 2018 was at 3,076, which was 24.7 percent higher than the reported
deaths by 2017.

Figure 3.13. Total reported HIV cases, persons living with HIV on Antiretroviral therapy, and
reported deaths
3. Rabies
The Rabies Prevention and Control Program aims to make the Philippines rabies-
free through two main strategies: reducing risks of rabies exposure, and appropriate
management of animal bites. The DOH implements rabies prevention and control
interventions in cooperation with the Department of Agriculture, Department of
Education, Department of Interior and Local Government, World Health Organization,
Animal Welfare Cooperation, LGUs, and other development partners. For 2018, the

38
 number of rabies-free areas increased to 62, from 41 areas in 2016. A total of 1,156,377
persons were given post-exposure rabies vaccines in 2018.

4. Filariasis
The National Filariasis Elimination Program further intensified its efforts to eradicate
filariasis by 2020. As of 2018, 40 (out of the 46 endemic provinces) have been declared
filariasis free. The latest areas to have been cleared of filariasis in 2018 were the
provinces of Basilan and Davao del Sur, and the cities of Isabela and Davao.

Figure 3.14. Cumulative number of Filiariasis free provinces

5. Malaria
The DOH aims to increase the proportion of malaria-free provinces to 91 percent
(74 out of 81) by 2022. In 2018, eight additional provinces were declared malaria-free,
namely: Agusan Del Sur, Bukidnon, Bulacan, Davao Occidental, Ifugao, Ilocos Sur,
Kalinga, and Pampanga. The proportion of malaria-free provinces in the country
increased to 61.7 percent (50 out of 81), from 51.8 percent in 2017. Twenty-seven
provinces, on the other hand, are now under elimination phase, and only four MALARIA

39
 Figure 3.15 Cumulative number of Malaria-free Provinces

6. Dengue

On 6 August, the Department of Health declared a dengue epidemic. With

nearly 361,000 dengue cases recorded and 1,373 deaths, the current dengue
epidemic is the largest in the last ten years, or since the disease has been monitored
in the Philippines.

7. Diphtheria

Almost 200 cases of diphtheria were reported by the Department of Health for
the period from 1 January to 5 October 2019, an increase of 47 per cent compared to
the same period in 2018. A significant number of diphtheria cases were reported in
the National Capital Region, Region IV-A and Cordillera Autonomous Region.

40
8. Measles

In February 2019, the Department of Health declared a measles outbreak in

five regions in the country, including Metro Manila. From 1 January to 12 October
2019, over 42,400 cases were reported by DOH. Severe complications from measles
have also claimed the lives of over 560 people. As of 25 October, the reported cases
of measles are declining as well as the case fatality rate.

9. Polio

On 19 September, the Department of Health confirmed the re-emergence of

polio in the Philippines and declared a national polio outbreak. As of 25 October,
thirteen environmental samples and three human samples of vaccine-derived polio
virus have been confirmed. Between October 2019 and January 2020, 4.4 million
children under 5 years of age will be vaccinated through vaccination campaigns.
(Department of Health (2018). Annual Report. Retrieved from:
https://www.doh.gov.ph/sites/default/files/publications/DOH%202018%20Annual%20Report
%20-%20Full%20Report.pdf)

Lesson 2. Components of the Philippine Health Care Delivery System

Philippine Department of Health

In order for the public health nurse to fully appreciate the public health system in this
country, it is important to have an understanding of the development of the government
agency mandated to protect the health of the people. The following historical account on the
institutional development of the Department of Health was referenced from the Souvenir
Program published during the 100th year anniversary of DOH (Cuevas, 2007).

Vision
Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by
2040

41
Mission
To lead the country in the development of a productive, resilient, equitable and
people-centered health system

Historical Background
Pre-Spanish and Spanish Periods (before 1898) Traditional health care practices
especially the use of herbs and rituals for healing were widely practiced during these
periods. The western concept of public health services in the country is traced to the first
dispensary for indigent patients of Manila ran by a Franciscan friar that was began in 1577.
In MM. Medicos Titulares, equivalent to provincial health officers were already existing. In
1888, a Superior Board of Health and Charity was created by the Spaniards which
established a hospital system and a board of vaccination, among others (Cuevas, 2007).

June 23, 1898

Shortly after the proclamation of the Philippine independence from Spain, the
Department of Public Works, Education and Hygiene was created by virtue al a decree
signed by President Emilio Aguinaldo. However, this was short lived because the Americans
took over and started a military and subsequently a civil government in the islands.

September 29, 1898

With the primary objective of protecting the health of the American soldiers, General
Orders No. 15 established the Board of Health for the City of Manila.

July 1, 1901
Because it was realized that it was impossible to protect the American soldiers
without protecting the natives, a Board of Health for the Philippine Islands was created
through Act No. 157. This also functioned as the local health board of Manila. It truly
became an Insular Board of Health when Act Nos. 307, 308 dated Dec. 2, 1901, established

42
the Provincial and Municipal Boards respectively completing the health organization in
accordance with the territorial division of the islands.

October 26, 1905

The Insular Board of Health proved to be inefficient operationally so it was abolished
and was replaced by the Bureau of Health under the Department of Interior through Act No.
1407. Act No. 1487 in 1906 replaced the provincial boards of health with district health
officers.

1912
Act No. 2156 also known as the Fajardo Act, consolidated the municipalities into
sanitary divisions and established what is known as the Health Fund for travel and salaries.

1915
Act No. 2468 transformed the Bureau of Health into a commissioned service called
the Philippine Health Service. This introduced a systematic organization of personnel with
corresponding civil service grades, and a secure system of civil service entrance and
promotion described as the "semi-military system of public health administration".

August 2, 1916
The passage of the Jones Law also known as the Philippine Autonomy Act, provided
the highlight in the struggle of the Filipinos for independence from the American rule. The
establishment of an elective Philippine Senate completed an all Filipino Philippine Assembly
that formed a bicameral system of government. This ushered in a major reorganization
which culminated in the Administrative Code of 1917 (Act 2711), which included the Public
Health Law of 1917.
1932
Because of the need to better coordinate public health and welfare services, Act No.
4007 known as the Reorganization Act of 1932, reverted back the Philippine Service into the

43
Bureau of Health, and combined the Bureau of Public Welfare under the Office of the
Commissioner of Health and Public Welfare.
The Philippine Commonwealth and the Japanese Occupation (1935-1945)

May 31, 1939

Commonwealth Act No. 430 created the Department of Public Health and Welfare,
but the full implementation was only completed through Executive Order No. 317, January 7,
1941. Dr. Jose Fabella became the first Department Secretary of Health and Public Welfare
in 1941.

1942
During the period of the Japanese occupation, various reorganizations and
issuances for the health and welfare of the people were instituted and lasted until the
Americans came in 1945 and liberated the Philippines.

October 4, 1947
Executive Order No. 94 provided for the post war reorganization of the Department
of Health and Public Welfare. This resulted in the split of the Department with the transfer of
the Bureau of Public Welfare (which became the Social Welfare Administration) and the
Philippine General Hospital to the Office of the President. Another split was created between
the curative and preventive services through the creation of the Bureau of Hospitals which
took over the curative services. Preventive care services remained under the Bureau of
Health. This order also established the Nursing Service Division under the Office of the
Secretary.

January 1, 1951
The Office of the President of the Sanitary District was converted into a Rural Health
Unit, carrying out 7 basic health services: maternal and child health, environmental health,
communicable disease control, vital statistics, medical care, health education and public
health nursing. This was carried out in 81 selected provinces. The impact to the community
was so strong, it directly resulted in the passage of the Rural Health Act of 1954 (RA 1082).

44
This Act created more rural health units and created posts for municipal health officers,
among other provisions.

February 20, 1958

Executive Order No. 288 provided for what is described as the most sweeping"
reorganization in the history of the Department at that period. This came about in an effort to
decentralize governance of health services. An Office of the Regional Health Director was
created in 8 regions and all health services were decentralized to the regional, provincial
and municipal levels. Bureaus were limited to staff functions such as policy making and
development of procedures. RHUs were made an integral part of the public health care
delivery system.

1970
The Restructured Health Care Delivery System was conceptualized. It classified
health services into primary, secondary and tertiary levels of care. This further expanded the
reach of the rural health units. Under this concept the public health nurse to population ratio
was 1:20,000. The expanded role of the public health nurse was highlighted.

June 2. 1978
With the proclamation of martial law in the country. Presidential Decree 1397
renamed the Department of Health to the Ministry of Health. Secretary Gatmaitan became
the first Minister of Health.

December 2, 1982
Executive Order No. 851 signed by President Ferdinand E. Marcos reorganized the
Ministry of Health as an integrated health care delivery system through the creation of the
Integrated Provincial Health Office which combines public health and hospital operations
under the Provincial Health Officers.

45
April 13, 1987
Executive Order No. 119. -Reorganizing the Ministry of Health" by President
Corazon C. Aquino saw a major change in the structure of the ministry. It transformed the
Ministry of Health back to the Department of Health. EO 119 clustered agencies and
programs under the Office for Public Health Services. Office for Hospital and Facilities
Services, Office for Standards and Regulations and Office of Management Services. The
Field Offices were composed of the Regional Health Offices and National Health Facilities.
The latter was composed of National Medical Centers, the Special Research Centers and
Hospital. Five deputy minister positions were also created.

October 10, 1991

Republic Act 7160 known as the Local Government Code provided for the
decentralization of the entire government. This brought about a major shift in the role and
functions of the Department of Health. Under this law, all structures, personnel and
budgetary allocations from the provincial health level down to the barangays were devolved
to the local government units (LGUs) to facilitate health service delivery. As such, delivery of
basic health services is now the responsibility of the LGUs. The Department of Health
changed its role from one of implementation to one of governance.

May 24, 1999

Executive Order No. 102 "Redirecting the Functions and Operations of the
Department of Health" by President Joseph E. Estrada granted the DOH to proceed with its
Rationalization and Streamlining Plan which prescribed the current organizational, staffing
and resource structure consistent with its new mandate, roles and functions post devolution.

The shift in policy and functions is indicated in the de-emphasis from direct service
provision and program implementation, to an emphasis on policy formulation, standard
setting and quality assurance, technical leadership and resource assistance. The shift in
policy direction of the DOH is shown in its new role as the national authority on health
providing technical and other resource assistance to concerned groups.

46
 E0102 mandates the Department of Health to provide assistance to local
government units. People’s organization, and other members of civic society in effectively
implementing programs, projects and services that will promote the health and well-being of
every Filipino; prevent and control diseases among population at risks: protect individuals,
families and communities exposed to hazards and risks that could affect their health; and
treat, manage and rehabilitate individuals affected by diseases and disability.

1999-2004
Development of the Health Sector Reform Agenda which describes the major
strategies, organizational and policy changes and public investments needed to improve the
way health care is delivered, regulated and financed.

2005 ongoing
Development of a plan to rationalize the bureaucracy in an attempt to scale down
including the Department of Health.

Figure 3.16 History of Department of Health

47
Sentrong Sigla Movement

Sentrong Sigla Movement was established by DOH with LGU’s having a logo of a
sun with 8 rays.

Goal: Quality Health

Objective: Better and more effective collaboration between DOH
and LGU’s
DOH: Provider of technical and financial assistance packages for
health care
LGU: Prime developers of health systems and direct
implementers of health programs

4 Pillars
1. Health promotion
2. Granted facilities
3. Technical assistance
4. Awards: Cash, plaque, certificates

Positive Outcome of Sentrong Sigla

 Created a quality service-orientation among public health service providers
 Promoted interest and participation of LGUs in raising quality health services
 Generated additional support from Local Chief Executive for health; channeled local
resources to fund supplies, basic, equipment of facilities
 Improved quality of services in general changed attitudes of service providers;
perceived increased utilization of services
 Effective tool to maintain DOH leadership in health that would ultimately redound to
health impact

Valuable Lessons
 Realization to the need for total systems quality standards that combine simple yet
basic input. process and output standards
 Importance of careful selection of incentives

48
Philippine Health Agenda 2016-2022: Goals and Objectives
Department of Health [DOH], (2016)

49
50
Stategies
Advance quality, health promotion and primary care
1. Conduct annual health visits for all poor families and special populations (NHTS, IP,
PWD, Senior Citizens)
2. Develop an explicit list of primary care entitlements that will become the basis for
licensing and contracting arrangements
3. Transform select DOH hospitals into mega-hospitals with capabilities for multi-
specialty training and teaching and reference laboratory
4. Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-wide
smoke-free or speed limit ordinances) 5. Establish expert bodies for health promotion
and surveillance and response
Cover all Filipinos against health-related financial risk
1. Raise more revenues for health, e.g. impose health promoting taxes, increase NHIP
premium rates, and improve premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with Phil Health
3. Expand Phil Health benefits to cover outpatient diagnostics, medicines, blood and
blood products aided by health technology assessment
4. Update costing of current Phil Health case rates to ensure that it covers full cost of
care and link payment to service quality
5. Enhance and enforce Phil Health contracting policies for better viability and
sustainability
Harness the power of strategic HRH development
1. Revise health professions curriculum to be more primary care-oriented and
responsive to local and global needs
2. Streamline HRH compensation package to incentivize service in high-risk or GIDA
areas
3. Update frontline staffing complement standards from profession-based to
competency-based
4. Make available fully-funded scholarships for HRH hailing from GIDA areas or IP
groups

51
 5. Formulate mechanisms for mandatory return of service schemes for all heath
graduates
Invest in eHealth and data for decision-making
1. Mandate the use of electronic medical records in all health facilities
2. Make online submission of clinical, drug dispensing, administrative and financial
records a prerequisite for registration, licensing and contracting
3. Commission nationwide surveys, streamline information systems, and support efforts
to improve local civil registration and vital statistics
4. Automate major business processes and invest in warehousing and business
intelligence tools
5. Facilitate ease of access of researchers to available data
Enforce standards, accountability and transparency
1. Publish health information that can trigger better performance and accountability
2. Set up dedicated performance monitoring unit to track performance or progress of
reforms
Value all clients and patients, especially the poor, marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and support them in
non-direct health expenditures
2. Make all health entitlements simple, explicit and widely published to facilitate
understanding, & generate demand
3. Set up participation and redress mechanisms
4. Reduce turnaround time and improve transparency of processes at all DOH health
facilities\
5. Eliminate queuing, guarantee decent accommodation and clean restrooms in all
government hospitals
Elicit multi-sectoral and multi-stakeholder support for health
1. Harness and align the private sector in planning supply side investments
2. Work with other national government agencies to address social determinants of
health

52
 3. Make health impact assessment and public health management plan a prerequisite
for initiating large-scale, high-risk infrastructure projects
4. Collaborate with CSOs and other stakeholders on budget development, monitoring
and evaluation (Department of Health [DOH] n.d.).

Universal Health Care

Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is
the provision to every Filipino of the highest possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by
an informed and empowered public. The Aquino administration puts it as the availability and
accessibility of health services and necessities for all Filipinos (Department of Health [DOH]
2012).

It is a government mandate aiming to ensure that every Filipino shall receive

affordable and quality health benefits. This involves providing adequate resources – health
human resources, health facilities, and health financing.

UHC’s Three Thrusts

To attain UHC, three strategic thrusts are to be pursued, namely: 1) Financial risk
protection through expansion in enrollment and benefit delivery of the National Health
Insurance Program (NHIP); 2) Improved access to quality hospitals and health care facilities;
and 3) Attainment of health-related Millennium Development Goals (MDGs).

1. Financial Risk Protection

Protection from the financial impacts of health care is attained by making any
Filipino eligible to enroll, to know their entitlements and responsibilities, to avail of
health services, and to be reimbursed by PhilHealth with regard to health care
expenditures.

53
 PhilHealth operations are to be redirected towards enhancing the national
and regional health insurance system. The NHIP enrollment shall be rapidly
expanded to improve population coverage. The availment of outpatient and inpatient
services shall be intensively promoted. Moreover, the use of information technology
shall be maximized to speed up PhilHealth claims processing.

2. Improved Access to Quality Hospitals and Health Care Facilities

Improved access to quality hospitals and health facilities shall be achieved in
a number of creative approaches. First, the quality of government-owned and
operated hospitals and health facilities is to be upgraded to accommodate larger
capacity, to attend to all types of emergencies, and to handle non-communicable
diseases. Financial efforts shall be provided to allow immediate rehabilitation and
construction of critical health facilities. In addition to that, treatment packs for
hypertension and diabetes shall be obtained and distributed to RHUs.

The DOH licensure and PhilHealth accreditation for hospitals and health
facilities shall be streamlined and unified. Further efforts and additional resources are
to be applied on public health programs to reduce maternal and child mortality,
morbidity and mortality from Tuberculosis and Malaria, and incidence of HIV/AIDS.
Localities shall be prepared for the emerging disease trends, as well as the
prevention and control of non-communicable diseases.

The organization of Community Health Teams (CHTs) in each priority

population area is one way to achieve health-related MDGs. CHTs are groups of
volunteers, who will assist families with their health needs, provide health
information, and facilitate communication with other health providers.

Another effort will be the provision of necessary services using the life cycle
approach. These services include family planning, ante-natal care, delivery in health
facilities, newborn care, and the Garantisadong Pambata package. Better

54
 coordination among government agencies, such as DOH, DepEd, DSWD, and DILG,
would also be essential for the achievement of these MDGs.

3. Attainment of Health-related MDGS

Public health programs are applied to reduce the maternal and child mortality,
morbidity and mortality from Tuberculosis and Malaria, and incidence of HIV/AIDS.

Devolution of health services

One of the most significant laws that radically changed the land-scape of healthcare
delivery in the country is RA 7160 or more commonly known as the Local Government
Code. The Code aims to: trans-form local government units into self-reliant communities and
active partners in the attainment of national goals through a more responsive and
accountable local government structure instituted through a system of decentralization.

In 1993, health services were devolved or transferred from the Department of Health
to the local government units -all provincial, district and municipal hospitals to the provincial
governments and the rural health units (RHUs) and barangay health stations (BHSs) to the
municipal governments.

Each province, city and municipality have a Local Health Board (LHB). This body is a
good venue for making the local health system more responsive to the needs of the people.
It is mandated to propose annual budgetary allocations for the operation and maintenance
of health facilities and services within the municipality, city or province.

At the provincial level, it is composed of the: governor (chair), provincial health officer
(vice chair), chairman of the Committee on Health of the Sangguniang Panlalawigan, DOH
representative and NGO representative. At the city and municipal level, the LHB is
composed of the following: mayor (chair), municipal health officer (vice chair), chair of the
Committee on Health of the Sangguniang Bayan, DOH representative and NGO
representative (Relaya, et. al., 2000).

55
Figure 3.17 DOH Functional Management Team
56
Organizational Structure of the Provincial Government

Governor

Provincial Health Board

Provincial Health office

Provincial District Other Health &

Hospital Hospital Medical Facilities

Municipal Health Office

Figure 3.18 Organizational Structure of the Provincial Government

Organizational Structure of the Municipal Government

Office of the Mayor

Municipal Health Board

Municipal Health office

Rural Health Unit Brgy. Health Station

Figure 3.19 Organizational Structure of the Municipal Government

Management Team
57
 At the municipal level, many public health nurses have been appointed as DOH
representatives. This means that they have been retained by the DOH. Many of them,
however, perform dual functions those of a public health nurse and those of a DOH
representative. Many of the local government units "cannot afford" to hire a replacement.
The DOH has allowed this set-up as a form of support to low-income municipalities.

The shift in the leadership in health care from the national government to the LGUs
has resulted in both the improvement and deterioration of health care delivery. There are
LGUs that are committed to health and are innovative while there are those that are just
interested in the purchase of supplies and medicines. Some LGUs have the financial
capability to support their own health care system while others do not have adequate
financial resources. It has been established that an LGU's financial capability, a dynamic
and responsive political leadership and community empowerment are the important
ingredients of an effective local health system (Maglaya, 2004).

Lesson 3. Levels of Health Care Facilities and Services

Health problems that are beyond the capability of PHC units and competence of
PHC workers are referred to and beyond the intermediate health facility, usually a Rural
Health Unit (RHU) located in a town or poblacion. The RHU team generally consists of the
physician, dentist, public health nurse, midwife, sanitarian and other health workers. The
District Community Hospital attends to cases needing hospitalization. Higher echelons of
health services at the provincial, regional and national levels, provide secondary or tertiary
care to complete the health care given at district and peripheral levels.

The higher the level, the more qualified the health personnel and the more
sophisticated the health equipment. Under this structure, health care is provided by the
suitable health facility on the basis of health need. There is better utilization of scarce health
resources (Reyala, et. al., 2000).

58
 More than ever, primary health care puts the concept of teamwork to the force. Team
planning by health personnel in the same level and the various health levels will be essential
for the effectiveness and efficiency of health services. For example, a nurse will plan family
health care with the midwife and community health workers. Together, you will set common
objective, delineate task, allocate resources and evaluate family services. You may need to
consult the hospital nurse for referral of seriously ill patients or coordinate with the sanitary
inspector for basic sanitation problems. The Chief Nurse of a community hospital may need
to plan with the Chief Nurse of a public health agency regarding a home care program.

Likewise, the Medical Health Officer plans priority community health programs with
the other members of the health team. Teamwork in primary health care entails joint
planning, implementation, and evaluation of community' activities by the team members with
the community health needs/problems as bases of action. Joint efforts in the implementation
of health programs is demonstrated by the health team in the expanded immunization
program where the nurse as team leader works with the midwife and other community
health workers (Relaya, et. al., 2000).
Table 3.2 Levels of health care facilities
Primary Prevention Secondary Prevention Tertiary Prevention
Health promotion and Prevention of complications Prevention of disability
disease prevention thru early diagnosis and
Treatment
Provided at: When hospitalization is When highly-specialized
 RHU deemed necessary and medical care is necessary
 Barangay Health referral is made to Referrals are made to
Stations emergency, provincial or hospitals and medical
regional or private hospitals center such as PGH, PHC,
POC, Nat’l Center for
Mental Health and other
Government, private
hospitals at the Municipal
level

59
 Figure 3. 22 Referral System

Levels of Health Care and Referral System

1. Primary Level of Care: Primary care is devolved to the cities and the municipalities. It

is health care provided by center physicians, public health nurses, rural health

midwives, barangay health workers, traditional healers and others at the barangay

health stations and rural health units. The primary health facility is usually the first

contact between the community members and the other levels of health facility.

2. Secondary Level of Care: Secondary care is given by physicians with basic health

training. This is usually given in health facilities either privately owned or government

operated such as infirmaries, municipal and district hospitals and out-patient

departments of provincial hospitals. This serves as a referral center for the primary

health facilities. Secondary facilities are capable of performing minor surgeries and

perform some simple laboratory examinations.

3. Tertiary Level of Care: Tertiary care is rendered by specialists in health facilities

including medical centers as well as regional and provincial hospitals, and

specialized hospitals such as the Philippine Heart Center. The tertiary health facility

is the referral center for the secondary care facilities. Complicated cases and

60
 intensive care require their health care and please be provided by the tertiary care

facility (Relaya,et al 2000).

Figure 3.121 Levels off Health Care

Table 3.3. Levels of Health Care Services

Reference Primary Secondary Tertiary
Clients Well clients Early sick Seriously ill w/ diagnosis
Workers Frontliners Clinicians With specialist
Facility PHC unit/ BHU/ District Hospital Regional/ National
RHU Emergency Hospital Hospital
City Hospital
Focus Promotion of Preventive, Prevention of further
health. Emergency/ curative complications
care,
Activities Primary Health Case finding/ Diagnosis/ treatment/
Care surveillance/ rehabilitation/
emergency restoration
care/identify early
signs and symptoms

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Lesson 4. The National Health Plan 2017-2022 (DOH, 2018)

FOURmula (F1)
Plus for Health builds on
the previous policy on F1
for Health initiated by the
DOH in 2005-2010, and the
Philippine Health Agenda
2016-2022, which was
committed to bringing “All
for Health towards Health
for All”. As the medium-
term strategic framework
for health, it supports the
attainment of the priority Figure 3.22 FOURmula One Plam for Health Strategy Map
thrusts of the Philippine
Development Plan (PDP) 2017-2022: Malasakit, Pagbabago at Patuloy na Pag-unlad by
helping realize its health-related objectives in the following priority areas: accelerating
human capital development, reducing vulnerability of individuals and families, building safe
and secure communities, reaching the demographic dividend, and ensuring ecological
integrity and clean and healthy environment (NEDA, 2017). Through this, F1 Plus for Health
supports the achievement of Ambisyon Natin 2040: Matatag, Maginhawa at Panatag na
Buhay – the long-term vision of the country, which sees Filipinos as having strongly rooted,
prosperous and secure lives.

It is likewise vital in realizing the health targets of Sustainable Development Goals

(SDG) 2030, particularly Goal 3 “Good health and well-being” and other health-related
targets in Goal 1 “No poverty”, Goal 2 “Zero hunger”, Goal 6 “Clean water and sanitation”,
Goal 7 “Clean energy”, Goal 11 “Sustainable cities and communities”, Goal 13 “Climate
action”, Goal 16 “Peace, justice and strong institutions, and Goal 17 “Partnerships for the
goals”.

62
 F1 Plus for Health goals will be measured by a set of sentinel impact indicators
which show the overall effectiveness of F1 Plus for Health strategies and interventions in
improving health system performance and bringing about desired health outcomes for all,
especially the poor (Department of Health [DOH] 2018).

AmBisyon Natin 2040

The Philippines is co-chairing the global SDG Interagency Expert Group on
Sustainable Development Indicators. As such, the country has fast tracked efforts to
develop national indicators and mainstream them into the national planning process. Under
the Philippines’ 25-year AmBisyon Natin 2040, the global vision aligns with the country’s
country development plans until 2040.

World Health Organization will work together with the Government of the Philippines
to help operationalize the country’s health agenda as well as the SDGs and other
international commitments. One of the strategic priorities to achieve this is the Promotion of
well-being by empowering people to lead healthy lives and enjoy responsive health services
(Department of Health [DOH] 2018).

Summary

1. Philippine Health Care System is a system is complex set of organizations interacting to

provide an array of health services. Which composed of two (2) sectors: the public and
private sectors (Cuevas 2007).
2. The National Health Situation gives us an idea of the health situation in the communities
where healthcare provider work.
3. Health Care Delivery System is operated by Department of Health a government agency
mandated to protect the health of the people.
4. Sentrong Sigla Movement was established by the Department of Health (DOH) to
provide technical and financial assistance packages for health care.
5. Philippine Health Agenda 2016-2022 is dedicated to enhancing the quality of life
of Filipinos by focusing on the achievement of the country's Sustainable
Development Goals for health, in partnership with government and other stakeholders
(Department of Health [DOH] 2016).

63
6. Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is the
provision to every Filipino of the highest possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded, fairly financed, and appropriately used
by an informed and empowered public (Department of Health [DOH] 2012).
7. The goal devolution of health services is to improve the efficiency and effectiveness of
health service provision by reallocation of decision making and resources to peripheral
areas. This is because the local units would know the current health situation in their
own localities (Reyala, et. al., 2000)
8. The Department of Health is composed of a policy board which is its policy-making and
coordinating body and a technical management committee which executes the plans
and activities of the DOH.
9. There are 3 different levels of health care system which are primary, secondary, and
tertiary. These referral systems are interlinked or interconnected to one another. Primary
level of care devolved to cities and municipalities. Usually the first contact between the
community members and other levels of health facility. Center physicians, public
health nurse, rural health midwives, Brgy. Health workers, traditional healers. Secondary
level of care usually given in health facilities either private owned or government
operated, infirmaries, municipal, district hospital, out-patient departments. The tertiary
level of care provides complicated cases and intensive care. Medical centers, regional
and provincial hospitals and specialized hospitals are examples of tertiary level.
10. The National Health Plan 2017-2020 committed to bringing “All for Health towards
Health for All”. As the medium-term strategic framework for health, it supports the
attainment of the priority thrusts of the Philippine Development Plan (PDP) 2017-2022:
Malasakit, Pagbabago at Patuloy na Pag-unlad by helping realize its health-related
objectives in the following priority areas: accelerating human capital development,
reducing vulnerability of individuals and families, building safe and secure communities,
reaching the demographic dividend, and ensuring ecological integrity and clean and
healthy environment (Department of Health [DOH] 2018).

64
 Assessment Task 3

1. What can you say about the health care delivery system in the Philippines?
2. Based on the National Health Situation in the Philippines as of 2018, answer
the following questions:
a. What would be the reason why there is a decreasing trend in the number of
registered live births from 2012 to 2018?
b. NCR mark as the highest occurrence of birth, what is the effect this in the
community?
c. Most of the child cases are said to be handled by the health care
professionals, what is the impact of this?
d. Highest number of deaths are recorded in Region IV-A. Considering that
you are in the living in this Region what are the thing that you might noticed
that could affect to the increased number of deaths in Region IV-A?
e. Why there is an increasing number of male deaths in the Philippines?
f. Among all Regions CALABARZON got the highest number of maternal
death in the year 2018, what do you think is/are the reason/s?
g. Why Ischemic Heart Disease and Cancer are the top leading cause of
death in the Philippines?
h. Despite of the programs created by the DOH why there’s still an increasing
number of TB and HIV/AIDS in the Philippines?
3. What can you say about the programs and actions of the Department of Health
in the community? Why (support your answer)?
4. We are more than half way through to the Philippine Health Agenda 2016-2022
presented by the Government, do you think we can still meet the goals and
objectives presented by the government? Support your answer.
5. What is the importance of levels of health care facilities and referral system?

65
 Assessment Task 4

The outbreak of coronavirus disease 2019 (COVID-19) has created a global health crisis
that has had a deep impact on the way we perceive our world and our everyday lives. on
your own knowledge and understanding about our current situation answer the following
questions:

1. How Corona Virus affecting our community?

2. What is the impact of COVID-19 to the Philippine Health Care Delivery System?
3. What is the current status of the Philippine Health Care Delivery System in this
pandemic?
4. What are the problems that you see in community brought by this pandemic?
5. What are the actions taken by the DOH in handling the COVID-19 pandemic?
6. Supposed you are one of the leaders in the Philippine Government what possible
solutions you think could help our health care system, our country and its people to
ease the suffering that we are experiencing right now?

References

Cuevas, F., Reyala, J., Earnshaw, R., Bonito, S., Sitioco, J., Serafica, L. (Eds.). (2007).
Public health nursing in the Philippines (10 th ed.) Philipines: Publication Committee,
National League of Philippine Government Nurses, Inc.
Department of Health (2018) Annual Report. Retrieved from:
https://www.doh.gov.ph/sites/default/files/publications/DOH%202018%20Annual%20
Report%20-%20Full%20Report.pdf
Department of Health (2018). National health plans. Retrieved from:
https://www.doh.gov.ph/sites/default/files/publications/NOH-2017-2022-030619-
1.pdf

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Department of Health (2016). Philippine health agenda Framework. Retrieved from:
https://www.doh.gov.ph/sites/default/files/basic-
page/Philippine%20Health%20Agenda_Dec1_1.pdf

Maglaya, A. (2004). Nursing Practice in the Community (4 th ed.) Marikina City, Philippines
Argonata Corp.
Relaya, J., Nisce, Z., Martinez, F., Hizon, N., Ruzol, C., Dequina, R., Alcantara, A.,
Bermudez, T., Estinopa, G. (2000). Community health nursing services in the
Philippines (9th ed.) Philippines: Publication Committee, National League of
Philippine Government Nurses, Inc.
Philippine Statistics Authority (2020) Birth in the Philippines. Retrieved from:
https://psa.gov.ph/content/births-philippines-
2018#:~:text=In%202018%2C%20a%20total%20of,16%20births%20per%20thousa
nd%20population.&text=On%20the%20average%2C%20there%20were,three%20b
abies%20born%20per%20minute.

Worldometer (2020). Philippine population. Retrieved from:

https://www.worldometers.info/world-population/philippines-population/

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